Periodontal Disease

Periodontal disease is an infectious process classified according to how much damage has been done to the structures surrounding the teeth, namely the gingiva (gums) and bone. It is an infection in your mouth. It can happen anytime, around your teeth, affecting some or many of your teeth to varying degrees. There are genetic predisposing factors to periodontal disease, and our immune systems play a role in gum health, but it is usually related to how well you are able to keep your teeth clean through proper oral self-care. The better you clean your teeth to remove all the plaque bacteria, the less likely you will be to develop periodontal disease.

Progress of the Disease

The bacteria that cause this disease first cause the gum tissue to become inflamed and pull away from the teeth. As the problem becomes more serious, the bone that supports the teeth also becomes infected and begins to break down and dissolve. The teeth then become loose. Once the bone disappears, it is extremely hard, if not impossible, for new bone to be rebuilt. The damage is permanent and your teeth, the surrounding bone, and your general health will be compromised.

Periodontal disease is classified into several types. The mildest form of this infection will show up in red and swollen gum tissue that bleeds easily. There is seldom any pain involved at this stage. You may also notice that your breath becomes offensive and you feel the need to use mouthwash. Our sense of smell does become immune to the same odor, so we can lose our ability to detect our own offensive, diseased breath. As the disease progresses, the gum tissue becomes more red and swollen, more bleeding can be seen, and the teeth begin to become loose. This tooth mobility is a sign that there is a severe problem. There may still be no pain at this advanced stage. As more and more bone is lost and more teeth become involved in the infection, it becomes harder to treat. At this point, many times, the management of your problem will involve periodontal surgical procedures. If this is the case, you may be referred to a periodontist (gum specialist) for further treatment. Most of the time, periodontal disease starts and continues because of neglect. Brushing and flossing of teeth are not being done effectively on a daily basis. You may have been neglectful in getting your teeth checked and cleaned within the time frame intervals you need. Once we have diagnosed the disease, we will inform you of the problem and suggest treatment. If treatment is not completed, however, the disease will continue to progress. Unfortunately, the disease is quite invisible to most people until severe and possible irreversible damage has occurred.

Solution

If it has been diagnosed in the early stages and has not progressed to bone loss, a proper cleaning (prophylaxis) will solve the problem. Scaling and root planing over multiple appointments may be needed for more advanced cases. In the most advanced cases, periodontal surgery and tooth loss are inevitable. You will receive an estimate of fees for the recommended treatment.

Periodontal disease is a condition that must be treated quickly. We believe that if the infection is aggressively treated in its early stages, conservative periodontal treatment may be possible and effective. Although we do not automatically rule out periodontal surgical intervention, we hope you can either avoid it or reduce the amount you will need.

Successful treatment of your periodontal problem will depend on several factors. But the most important of these is your ability to perform excellent oral self-care—brushing, flossing, and the use of periodontal aids—on a routine, daily basis. Without this, periodontal treatment will fail, and the disease will return. 

Gingival Grafts

What is it?
Periodontal (gum) surgery is most often associated with the removal of soft tissue. But there are times when it is necessary to use soft tissue to cover an area that has too little soft tissue remaining. 

What causes it?
Exposed roots may be due to the improper brushing, periodontal disease, or genetic structure. Brushing too hard and/or with a hard toothbrush can cause the gingival tissue to disappear. The gingival margin (gumline) changes, and one or more millimeters of root structure can be exposed. Active periodontal disease can cause loss of this soft tissue too. 

Why you should care
This exposure can lead to teeth that are very sensitive to temperature changes, root decay, or are quite unsightly. The disfigured soft tissue line can lead to a plaque trap, causing more disease and further problems.

How dentists fix it
Two methods of resolving these problems are free gingival grafts and attached gingival grafts. Both of these are periodontal surgical procedures. In both cases, a local anesthetic will be used to numb the treatment site. 
In the case of an attached graft, gingival tissue is taken from the donor site and moved to the area where root coverage is required. The graft tissue is sutured into place, and a dressing is placed over the treated area. The dressing remains in place for several weeks and is then removed. An attached graft is not completely removed from the donor site. The donor site is adjacent to the site that needs root coverage. There is an incision made in the gum tissue, and the tissue is moved sideways, up, or down and sutured into place. Again, a protected dressing is placed to protect the area while healing occurs. Any anticipated postoperative discomfort is resolved with medication. Most discomfort will come from a free graft donor site.

Who performs the procedure?
A periodontist (gum specialist) usually performs these procedures, as well as other types of grafts and root coverage treatments. After the periodontist examines the areas needing treatment, you will have a better idea of what treatment will consist of, what the appearance may be, anticipated healing times, postoperative discomfort, and cost.

How can you prevent it?

Most patients have heard that they should take better care of their teeth - brush and floss the teeth. Some patients brush too hard and in a back-and-forth motion; and some facial, bony structures and biting forces are such that root exposure happens, resulting in longer looking teeth. The grafting procedures mentioned here can restore the proper gingival marginal architecture, prevent root decay, reduce or eliminate thermal sensitivity, and make your smile look great again.

If you have any questions about gingival grafts, please feel free to ask us.

Am I Grinding My Teeth At Night?

How do you find out if you are grinding your teeth at night? Many patients are often unaware that they have this problem. Some people do grind or clench their teeth during the day, but it oftentimes occurs at night when the person is asleep. Because of this, it can be difficult to self-diagnose.

Ways to find out

• When you wake up, are you in pain?
• Such pressure applied can cause a tooth to hurt or cause soreness in the jaw muscles.
• Does someone observe you grinding your teeth while you are sleeping?
• Many people who grind their teeth at night will make repetitive clicking or grinding noises while sleeping. They will not make these noises all night long, but instead exhibit repeated short periods of grinding/clenching activity.
• Does your front teeth look worn when you look in the mirror?
• Do you experience these symptoms when you wake up?

• A dull, constant headache
• A sore jaw
• Audible teeth grinding sounds as you are falling asleep
• Tooth sensitivity to heat, cold, or brushing
• Inflammation of the gums (gingivitis)
• Wounds on the inside of the cheeks (from biting)

Ask your dentist because chronic teeth grinding can result in fracturing, loosening, or the loss of teeth.Your dentist can observe the wear patterns on your teeth and examine your mouth and jaw for signs of grinding, such as jaw tenderness, worn-down teeth, and other abnormalities. They will also check to make sure that you are not suffering from some other ailment that cause similar pain, such as: dental disorders, ear disorders, or TMD.

How to fix

•  Ask your dentist

• Dentists often recommend that patients wear a night guard in order to protect teeth and jaws from further damage. Many patients who do wear a night guard report that they feel better in the mornings. A previous blog post goes over the process of getting a bite guard.
• Muscle relaxants can be prescribed
• Crowns or onlays can be put onto your teeth to fix any damage caused to the teeth and repair your bite
• Understand bruxism: it is a condition where a person grinds, gnashes, or clenches his teeth unconsciously. 
• Reduce your stress. The degree of severity can be influenced by the amount of stress that someone is experiencing. Many patients who are aware of their nocturnal bruxing report that it can be worse during stressful periods of their lives.

• Stress counseling, exercising, meditating
• Eliminate major sources of stress in your life
• Go to bed and wake up at the same time every day
• Have fun with family and friends
• Eat well: three well-balanced and healthy meals each day
• Relax before bed
• Reduce stress on your mouth
• Stop chewing non-foods (chewing on pencils)
• Train yourself not to clench your jaw during the day
• If your muscles feel sore, you can apply ice to your jaw to alleviate the pain
• If your jaw hurts, you can take a pain reliever like ibuprofen for temporary relief